NHS performance dashboard
1. Urgent care
Since June 2012 ambulance trusts have been given 8 minutes to respond to the most urgent cases and nationally no more than 25 per cent of these calls should be responded to outside of this time.
This standard was met until 2013/14 but for all subsequent years has been missed. The most recent data shows performance remains poor, 29 per cent of calls were responded to after 8 minutes in March 2017 (Figure 41). It is now 22 months since the target was met.
Data source: Ambulance quality indicators www.england.nhs.uk
Accident and emergency
In quarter four 2016/17 the proportion of patients waiting more than four hours from arrival to discharge, admission or transfer in all A&E departments was 12.4 per cent, the worst performance ever recorded for this target (Figure 42). More than 699,000 patients waited more than four hours during quarter four.
Over the year, the four-hour target was not met in any month, and 11 per cent of patients (more than 2.5 million) spent more than four hours in A&E before admission, transfer or discharge. This is the worst annual performance for this target that we’ve seen.
This is also the third year in a row that the four-hour standard has not been met for the year in aggregate, with performance deteriorating year on year.
The poor performance in quarter four 2016/17 was despite a small reduction in attendances. Compared to the same quarter last year, A&E attendances were 4 per cent lower this year (Figure 43), while emergency hospital admissions from A&E were unchanged (Figure 44).
The small percentage decrease represents a large number of attendances. The decrease equates to almost 209,000 fewer attendances in quarter four 2016/17 compared to the same quarter 2015/16.
Over the year, however, there were overall increases in the number of attendances at, and admissions from, A&E. In 2016/17, there were an additional 451,500 attendances (up 2 per cent) and 118,200 more admissions (up 3 per cent) in 2016/17 compared to 2015/16.
Compared to 2012/13, attendances at A&E departments in England are now 7 per cent higher, an increase of more than 1 million additional attendances. There are also approximately 482,000 more emergency admissions from A&E, an increase of 13 per cent.
The number of patients waiting more than four hours from decision to admit from A&E to admission to a hospital bed on a ward (‘trolley waits’) remains high. In quarter four 2016/17 more than 177,000 patients spent more than 4 hours waiting for admission, of these, just under 1,600 patients waited more than 12 hours.
This is approximately 22,000 (14 per cent) more patients spending more than 4 hours in A&E waiting for admission in quarter four 2016/17 than the same quarter 2015/16 (Figure 45).
Over the year, more than 560,000 patients spent longer than four hours in A&E before they were admitted. This is almost 172,000 (44 per cent) more patients waiting more than 4 hours than in 2015/16 and is more than 407,000 (267 per cent) additional patients compared to 2012/13.
2. Waiting times
The proportion of patients waiting more than 18 weeks to begin their treatment fell to less than 10 per cent in March 2017 (Figure 46). This is the fourth month in a row that performance has improved. However, it is the 13th month in a row that the target (8 per cent) has been breached.
In total, there were more than 362,600 patients still waiting to begin their treatment after 18 weeks at the end of March 2017, and 1,529 of these patients have been waiting for more than a year.
For the first time since this target was introduced, in April 2012, the 18-week target was not met for a full year.
However, there have never been more patients beginning elective treatment within 18 weeks. In 2016/17, almost 40 million patients began treatment within 18 weeks, this is 3.6 million (10 per cent) more patients than 2015/16 and 10.6 million (36 per cent) more patients than 2012/13.
The total elective waiting list grew to 3.73 million in March 2017. This is 131,000 more patients than in April 2016.
Furthermore, this total does not include several trusts that have not been reporting their waiting lists. Including these trusts, NHS England estimates that the true waiting list in March 2017 was more than 3.9 million patients (Figure 47).
Data source: Referral-to-treatment waiting times statistics www.england.nhs.uk
The proportion of patients waiting more than six weeks for a diagnostic test has now missed its target (1 per cent) for the past 40 months in a row (Figure 46).
During 2016/17, there were more than 15.7 million diagnostic waiting list tests carried out. This is around 620,500 (4 per cent) more tests than 2015/16 and more than 3.1 million (25 per cent) more tests than 2012/13.
The overall waiting times target for cancer treatment is that no more than 15 per cent of patients should wait more than 62 days from an urgent referral from their GP to receiving treatment for their cancer. This target was met from quarter four 2008/9 until quarter four 2013/14, when it was missed (15.6 per cent of patients waited more than 62 days).
In the latest quarter (quarter four 2016/17 (January to March 2017)) performance worsened, with almost 19 per cent of patients waiting more than two months for treatment, this is the worst-ever performance for this target (Figure 48). It is also the 13th quarter in a row that this target has been missed.
Over 2016/17, more than 146,000 patients received treatment for cancer following an urgent referral from their GP. This is the highest number we’ve seen and represents 7,900 (6 per cent) more patients than 2015/16 28,000 (24 per cent) more patients than 2012/13.
Data source: Provider-based cancer waiting times www.england.nhs.uk
For patients accessing mental health services, there are currently three waiting time targets; 75 per cent of patients referred to the Improving Access to Psychological Therapies (IAPT) service should begin treatment within 6 weeks of referral, with 95 per cent beginning treatment within 18 weeks. For patients experiencing a first episode of psychosis, more than 50 per cent should be treated within two weeks of referral using a National Institute for health and Care Excellence-approved package of care.
Data from 2016/17 show that, over the year, 74 per cent of patients accessed early intervention in psychosis services within two weeks (Figure 49).
For patients accessing psychological therapies, both the target for 75 per cent of patients accessing IAPT services within 6 weeks, and 95 accessing services within 18 weeks, were met for every month in 2016/17 (to date) (Figure 50).
Data source: Early Intervention in Psychosis Waiting Times www.england.nhs.uk
Data source: Improving Access to Psychological Therapies www.digital.nhs.uk
3. Delayed transfers of care
At the end of March 2017, 6,622 patients were delayed in hospitals. Though a decrease on previous months, this is the highest number published for this time of year since the data began and is an increase of 16 per cent since March 2016 (Figure 51).
Over 2016/17 more than 78,000 patients were delayed in hospital at the end of the month. This is the highest we’ve seen in this data and represents almost 15,000 (23 per cent) more patients than 2015/16 and 30,000 (63 per cent) more patients compared with 2012/13.
The number of total days delayed increased to more than 199,000 in March 2017, the highest ever recorded for March (Figure 52) and 17 per cent higher than March 2016.
Over 2016/17 almost 2.25 million bed days were lost due to delayed transfers of care, the highest we’ve seen in this data. This is more than 441,000 (24 per cent) more delayed days compared to 2015/16 and more than 866,000 (63 per cent) additional delayed days compared to 2012/13.
Data source: Acute and non-acute delayed transfers of care, patient snapshot, 2016/17 www.england.nhs.uk
Data source: Acute and non-acute delayed transfers of care, total days delayed, 2016/17 www.england.nhs.uk
General practice performance
In this section, we have used data from ResearchOne, a health and care research database created using records held on TPP’s SystmOne, one of the main providers of information systems in general practice in England, to compare the amount of activity experienced in a sample of 202 practices (approximately 2.7 per cent of all practices in England) in 2016/17 with the same period in 2014/15. Our previous report on this data (QMR21) covered the first two quarters of 2016/17, and this report adds quarters three and four to that analysis.
Within our sample, there has been an increase in total contacts with general practice of 7.5 per cent between 2014/15 and 2016/17. The increase in the number of contacts in our sample continues to rise faster than the increase in registered population (see below).
Over the same period, the average number of patients registered with each practice in our sample increased by 6.2 per cent. This increase in was lower than the national average between 2014/15 and 2016/17 (7.2 per cent). The increase in the national average is being driven by two factors in particular – the continuing rise in the number of patients registering in England (up 2.4 per cent) and a reduction in the number of practices operating in the country (from 7,875 in 2014 to 7,527 in 2016) as practices merge.
As we reported in QMR21 (November 2016), in our sample the number of telephone contacts has been increasing at a faster rate than face-to-face contacts for the past 6 years. This trend continued through quarters three and four of 2016/17, with 24 per cent growth in the number of telephone contacts compared to the same quarters in 2014/15 but only a 2.8 per cent growth in face-to-face contacts (Figure 53).
The share of appointments taken by the oldest patients (aged 85 and over) increased at the same rate in quarters three and four of 2016/17 as it did in quarters one and two, with 25 per cent more contacts compared with quarters three and four in 2014/15 (Figure 54).
It should be noted that although growth in the number of contacts with people in older age groups was highest, the majority of contacts (approximately 55 per cent) continue to be with people aged 18–64 .
At the same time as the use of general practice has increased, the number of GPs has been largely steady, with a marginal drop between 2015 and 2016 (Figure 55). (The number of GPs in the years prior to 2015 cannot be compared to the data for 2015 and 2016, as there was a significant change in the way the data was collected).
There were increases in the number of nurses employed in primary care and the number of ‘direct patient care’ staff (such as health care assistants, pharmacists and allied health professionals) between 2015 and 2016, with a 2.8 per cent increase in nursing full-time equivalents (FTEs) and a 9.4 per cent increase in direct patient care staff FTEs (Figure 56).
These changes in staffing at the national level are not yet showing up in our activity data sample. The share of activity by different staff groups hasn’t changed significantly in the past three years, with GPs undertaking around three-quarters of the contacts and nurses around a quarter.
Referrals from primary to secondary care have remained at historically high levels, though the quarterly trend flattened in 2016/17 after rising at a faster rate between 2012/13 and 2015/16 (Figure 57). If the data is examined on an annual or monthly basis, there are two notable points in the 2016/17 data: first, the annual total for 2016/17 is the highest since the dataset began (14 million referrals, 200,000 more than in 2015/16), and second, the monthly total for March 2017 was the highest on record (1.3 million, 100,000 more than the previous high in July 2015).
General and Personal Medical Services, England 2006-2016, as at 30 September, Experimental statistics, NHS Digital- March 2017
Monthly Hospital Activity Data, NHS England- March 2017